April - 2013
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A Randomized Trial of Glutamine and Antioxidants in Critically Ill Patientsthe Canadian Critical Care Trials Group New Engl J Med, 2013, 368:1489-1497 This page is only available to Crit-IQ subscribers. To view the rest of this review and gain access to our vast array of critical care teaching tools including podcasts, vodcasts, modules, exam preparation tools, teaching aids and much more, login here, or Become a Member to register |
April |
Previous Comments
| Could it be that parenteral nutrition is likely to render patients "glutamine deficient" and, together with a bit of survivor bias in late recruitment, the harmful effects are then intrinsically harder to detect using the previous trial designs? G Van den Bergh's group in Leuven presented a post hoc analysis (I know) of their EPaNIC study data showing a dose related increase in mortality by quintiles of energy provision, enteral or parenteral. The effect was seen more in parenteral, and more in protein, energy and seemed to disappear with glucose energy (Casaer et al AJRCCM 2013, vol 188 somewhere I think). Taken together, this is enough for me to lose equipoise for any future trial of peptide supplementation, even enterally without some good mechanistic and pilot data. What does everyone else think? | |
| LTC-22 Apr, 2013 10:15:29 AM | |
Comment
The interest in anti-oxidants and glutamine has been bubbling away in the critical care literature, with evidence suggesting benefit, but no definitive large multicenter RCT.This 1223 patient, 40 ICU, blinded 2 by 2 factorial trial randomised ventilated patients to supplements of...